© Royal College of Physicians of Ireland, 2017 1
Post CSCST Training in
OBSTETRICS & GYNAECOLOGY Advanced Gynaecological Surgery
© Royal College of Physicians of Ireland, 2017 2
This curriculum of t raining in Advanced Gynaecological Surgery was developed in 2017 and undergoes an annual review by Donal Brennan /Noreen Gleeson , Subject matter Experts, Dr Ann O’Shaughnessy, Head of Education, Innovat ion & Research and by the Obstetr ics and Gynaecology Training Committee. The curriculum is approved by the Faculty of Obstetrics & Gynaecology.
Version Date Published Last Edited By Version Comments
0.0 01/07/2017 Ann Coughlan New Curriculum
Advanced Gynaecological Surgery Post CSCST Fellowship Table of Contents
© Royal College of Physicians of Ireland, 2017 3
Table of Contents
INTRODUCTION ............................................................................................................................................... 4
ENTRY REQUIREMENTS ............................................................................................................................................. 4 RECRUITMENT AND SELECTION ................................................................................................................................... 4 DURATION AND ORGANISATION OF TRAINING ............................................................................................................... 4 TRAINEE NUMBERS .................................................................................................................................................. 5 EPORTFOLIO ........................................................................................................................................................... 5 PROGRAMME MANAGEMENT .................................................................................................................................... 5
SPECIALTY SECTION ......................................................................................................................................... 6
OPEN BENIGN GYNAECOLOGICAL SURGERY .................................................................................................................... 7 LAPAROSCOPIC BENIGN ABDOMINAL SURGERY ............................................................................................................... 8 HYSTEROSCOPIC BENIGN SURGERY ............................................................................................................................... 9 DIAGNOSTIC HYSTEROSCOPY - OUTPATIENT SETTING ..................................................................................................... 10
DOCUMENTATION OF MINIMUM REQUIREMENTS FOR TRAINING ................................................................ 11
Advanced Gynaecological Surgery Post CSCST Fellowship Introduction
© Royal College of Physicians of Ireland, 2017 4
Introduction This post CSCST Fellowship in the sub specialty of Advanced Gynaecological Surgery provides special interest training in hysterectomy, laparoscopy and benign open gynaecological surgery. Following completion of this programme the trainee should be able to choose the most appropriate care pathway for the patient following acquisition of hysteroscopic, laparoscopic and benign open gynaecological surgery skills. The trainee should also know when to refer more complex cases. A simulation course in minimally invasive surgery should be completed prior to commencing this module. Specifically once trained the Fellow should:
be clinically competent and confident in all aspects of assessment of patients for major
gynaecological surgery
be able to select and counsel appropriate patients for laparoscopic, hysteroscopic or open
surgery
be clinically competent in performing abdominal hysterectomy with and without oophorectomy
for benign disease.
be clinically competent in performing surgery to the ovary, including post-hysterectomy
oophorectomy
be clinically competent in performing other appropriate abdominal procedures, including
adhesiolysis
be clinically competent in laparoscopy skills, including laparoscopic hysterectomy and
laparoscopically assisted vaginal hysterectomy in uncomplicated cases.
have a thorough understanding of complications of surgery, how to manage them and when
to involve other specialists
be able to undertake and use clinical audit
be able to write evidence-based guidelines
be aware of the limits of their skills and to refer patients to appropriate colleagues as
necessary
Requirements: At least 3 surgical sessions per week
2 surgical audits must be undertaken during the module
Module may be delivered in more than one unit.
Entry Requirements
Applicants for the Post CSCST Fellowship in Advanced Gynaecological Surgery will have successfully completed the RCPI Higher Specialist Training programme in Obstetrics and Gynaecology within two years of the start date of the Post CSCST Fellowship programme. Prior experience in Advanced Gynaecological Surgery during Obstetrics and Gynaecology training would be an advantage.
Recruitment and Selection
Post CSCST Fellowship training in Advanced Gynaecological Surgery will build on broad basic and early core specialist training in Obstetrics and Gynaecology. This is in line with training models internationally. Selection of candidates for Post CSCST Fellowship training in Advanced Gynaecological Surgery will be via a competitive recruitment process coordinated by the relevant Training Body. Recruitment will follow similar timeline where possible to HST recruitment and post will commence in July of each year (unless otherwise specified).
Duration and Organisation of Training
The Post CSCST Fellowship in Advanced Gynaecological Surgery is a one year training programme designed to dovetail with the Irish Higher Specialist Training programme in Obstetrics and Gynaecology. The curriculum is competency-based, however it is anticipated that the candidate will complete training within one year.
Advanced Gynaecological Surgery Post CSCST Fellowship Introduction
© Royal College of Physicians of Ireland, 2017 5
The curriculum takes into account the major areas of competence required by the subspecialist in Advanced Gynaecological Surgery and will be supervised by the Faculty of Obstetrics and Gynaecology of the Royal College of Physicians in Ireland. Doctors who have successfully completed the RCPI Higher Specialist Training programme in Obstetrics and Gynaecology and are within two years of completion will be deemed eligible to apply for the Post CSCST Fellowship in Advanced Gynaecological Surgery. Completion of this program will ensure the knowledge and competencies in all areas of the curriculum, meeting international standards for best practice and allowing candidates to practice as a subspecialist in Advanced Gynaecological Surgery
Training Programme
The training programme offered will provide opportunities to fulfil all the requirements of the curriculum of training for Advanced Gynaecological Surgery in approved training hospitals. Each post within the programme will have a named trainer/educational supervisor and the programme will be under the direction of the National Specialty Director in Obstetrics and Gynaecology
Trainee Numbers
It is expected that the Post CSCST Fellowship in Advanced Gynaecological Surgery will be awarded to one candidate per year.
ePortfolio
The trainee will be required to keep their ePortfolio up to date and maintained throughout their
Fellowship training. The ePortfolio will be countersigned as appropriate by the Trainer to confirm the
satisfactory fulfilment of the required training experience and the acquisition of the competencies set
out in the Curriculum. This will remain the property of the Trainee and must be produced at the end of
year Evaluation meeting. At the end of year Evaluation, the ePortfolio will be examined. The results of
any assessments and reports by the named trainer/educational supervisor, together with other material
capable of confirming the trainee’s achievements, will be reviewed.
Programme Management
Coordination of the training programme will lie with the Medical Training Department.
The training year will usually run from July to July in line with HST programmes
Annual evaluations will usually take place between April and June each year
Each trainee will be registered to the ePortfolio and will be expected to fulfil all requirements
relating to the management of yearly training records
Opportunities for audit and research may be available
Each trainee will be issued with a training agreement on appointment to the training programme and will be required to adhere to all policies and procedures relating to Post CSCST Fellowships.
Advanced Gynaecological Surgery Post CSCST Fellowship Minimum Requirements for Training
© Royal College of Physicians of Ireland, 2017 6
Specialty Section
Advanced Gynaecological Surgery Post CSCST Fellowship Minimum Requirements for Training
© Royal College of Physicians of Ireland, 2017 7
Open benign gynaecological surgery
Objective: To understand and demonstrate knowledge, skills and attitudes in relation to
open abdominal gynaecological surgery.
Knowledge
Understand the anatomy and innervation of the genital tract
Knowledge of equipment, instrumentation and theatre set-up
Understand the principles of diathermy Awareness of potential risks and complications of abdominal surgery (including anaesthesia)
Understand the principles and management of major haemorrhage
Knowledge of emergency hysterectomy procedures, complications and risks
Skills
Appropriate selection of patients appropriately for abdominal surgery
To perform: o abdominal hysterectomy +/- bilateral salpingo -oophorectomy (BSO) o oophorectomy ovarian cystectomy o myomectomy
Adhesiolysis drainage of pelvic abscess post-hysterectomy oophorectomy
Be able to identify the ureter
Be able to identify the internal iliac artery
Control major haemorrhage
Recognise damage to bowel and bladder and be aware of repair procedures
Recognise intraoperative complications and management
Management of postoperative complications
Awareness of clinical scenarios where emergency hysterectomy is necessary
To provide counselling regarding the options for the management of benign gynaecological conditions, provide
counselling regarding abdominal surgery, complications and alternatives
Awareness of long-term complications of abdominal surgery
Assessment and Learning
Observation of techniques and then practice with assistance from supervisor o hysterectomy o opening and closing abdomen using vertical incision
Audit of cases
OSATS: o Hysterectomy o Opening and closing the abdomen using vertical incision
Log of cases: TAH +/- BSO x 20 (minimum) at level 5 Competence. (No OSATS until 10 completed)
Minimum of five cases of : o oophorectomy o ovarian cystectomy o myomectomy o adhesiolysis o drainage of pelvic abscess o post-hysterectomy oophorectomy
Advanced Gynaecological Surgery Post CSCST Fellowship Minimum Requirements for Training
© Royal College of Physicians of Ireland, 2017 8
Laparoscopic benign abdominal surgery Objective: To understand and demonstrate knowledge, skills and attitudes in relation to
laparoscopic abdominal and gynaecological surgery.
Knowledge
Anatomy of the abdomen, female genital tract, bladder, ureters and lower bowel
Knowledge of laparoscopic equipment and theatre set-up
The principles of safe use of energy sources
Knowledge of safe entry techniques and port site problems
Knowledge of potential risks and complications specific to laparoscopic surgery (including anaesthesia)
Knowledge of the contribution of preoperative investigations, particularly CA125 and transvaginal ultrasound scan findings
Knowledge of the pathological processes involved in ovarian disease and endometriosis
Skills
Set up laparoscopic equipment, the theatre environment, patient positioning, optimisation and recording of images
Proficiency in Veress needle, Hasson direct and Palmer’s point entry techniques
Position and safe insertion of secondary ports
Assess peritoneal cavity including ureteric visualisation
Proficiency in safe tissue handling with laparoscopic instruments, sharp and blunt dissection
Correct use of various haemostatic techniques
Provide counselling regarding benefits, risks and alternatives to laparoscopic surgery
Recognition of the limitations of their operative laparoscopic surgery skills
Ability to select patients appropriately for operative laparoscopy
Correct use of tissue retrieval techniques
Perform laparoscopic suturing
Checks for bladder and bowel integrity
Be able to recognise intraoperative complications and manage them, including when to convert to an open procedure
Be able to recognise delayed-onset complications
Proficiency in the performance of adhesiolysis
Proficiency in the performance of ovarian cystectomy and oophorectomy
Proficiency in the performance of excision and ablation of peritoneal endometriosis and ovarian endometrioma
Proficiency in the laparoscopically assisted vaginal hysterectomy and laparoscopic hysterectomy
Assessment and Learning
OSATS: Operative laparoscopy (do not introduce until at least 10 have been performed, then commence logbook)
Case logbook: o Adhesiolysis x 10(min) o Ovarian cystectomy and oophorectomy x 10(min) o excision and ablation of peritoneal endometriosis and ovarian endometrioma x o 10(min) o laparoscopically assisted vaginal hysterectomy and laparoscopic hysterectomy x
10(min)
Advanced Gynaecological Surgery Post CSCST Fellowship Minimum Requirements for Training
© Royal College of Physicians of Ireland, 2017 9
Hysteroscopic benign surgery Objectives: The safe use of hysteroscopic surgery for benign surgical conditions
Knowledge
Knowledge of instruments
Principles of safe use of energy sources; distension media
Knowledge of o potential complications o methods of endometrial preparation o outpatient/office methods of diagnosis and treatment
Skills
Ability to: o perform first-generation endometrial ablation o transcervical resection of the endometrium
o (TCRE)/transcervical resection of fibroid (TCRF) o resect submucous fibroids grade 0–2 o resect intrauterine adhesions/septum o Ability to manage difficult cervical dilatation
Use of the loop ball, Collins knife and bipolar electrodes
Manage complications intra- and postoperatively
Provide counselling regarding hysteroscopic surgery, complications and alternatives
Ability to perform hysteroscopic procedures in a fluent and safe manner
Demonstration of safe use of electro-surgery
Demonstration of safe hysteroscopic fluid management
Assessment and Learning
OSATS: Operative hysteroscopy (do not introduce until at least 10 have been performed, then commence logbook)
Record of cases: o first-generation endometrial ablation / transcervical resection of the endometrium /
(TCRE)/transcervical resection of fibroid (TCRF) x 20(min) o resect submucous fibroids grade 0–2 x 5(min) o resect intrauterine adhesions/septum x 5(min)
Advanced Gynaecological Surgery Post CSCST Fellowship Minimum Requirements for Training
© Royal College of Physicians of Ireland, 2017 10
Diagnostic Hysteroscopy - outpatient setting Objectives: The safe use of hysteroscopic surgery in diagnosis
Knowledge
Knowledge of instruments
Principles of safe use of energy sources; distension media
Knowledge of o potential complications o methods of endometrial preparation o outpatient/office methods of diagnosis and treatment
Skills
Ability to manage difficult cervical dilatation
Manage complications intra- and postoperatively
Assessment and Learning
OSATS
Advanced Gynaecological Surgery Post CSCST Fellowship Minimum Requirements for Training
© Royal College of Physicians of Ireland, 2017 11
Documentation of Minimum Requirements for Training These are the minimum number of cases you are asked to document as part of your training. It is recommended you seek opportunities to
attain a higher level of exposure as part of your self-directed learning and development of expertise.
You should expect the demands of your post to exceed the minimum required number of cases documented for training.
If you are having difficulty meeting a particular requirement, please contact your specialty coordinator.
Curriculum Requirement Required/Desirable Minimum Requirement Reporting Period
Form Name
Section 1 - Training Plan Personal Goals Plan (Copy of agreed Training Plan for the module signed by both Trainee & Trainer) Required 1
Training Programme Form 052
Weekly Timetable (Sample Weekly Timetable for module) Required 1 Training Programme Form 045
On Call Rota (where appropriate) Required 1 Training Programme Form 064
Section 2 - Training Activities
Benign Gynaecological Surgery Sessions (Min 3 per week) Required 120 Training Programme Form 002
Procedures/Practical Skills/Surgical Skills
TAH+/- BSO Required 20 Training Programme Form 004
Oophorectomy Required 5 Training Programme Form 004
Ovarian Cystectomy Required 5 Training Programme Form 004
Adhesioloysis Required 10 Training Programme Form 004
Drainage of pelvic abscess Required 5 Training Programme Form 004
Post-hysterectomy Oophorectomy Required 5 Training Programme Form 004
Ovarian Cystectomy and Oophorectomy Required 10 Training Programme Form 004
Excision/ablation of peritoneal endometriosis and ovarian endometrioma Required 10 Training Programme Form 004
Laparascopically assisted vaginal hysterectomy and laparoscopic hysterectomy
Required 10 Training Programme
Form 004
First generation endometrial ablation/TRCE/TRCF Required 20 Training Programme Form 004
Resect submucous fibroids grade 0-2 Required 5 Training Programme Form 004
Resect intrauterine adhesions/septum Required 5 Training Programme Form 004
Audit activities
Surgical Audit Required 2 Training Programme Form 015
Advanced Gynaecological Surgery Post CSCST Fellowship Minimum Requirements for Training
© Royal College of Physicians of Ireland, 2017 12
Curriculum Requirement Required/Desirable Minimum Requirement Reporting Period
Form Name
Section 3 - Educational Activities
Teaching basic practical skills Required 1 Training Programme Form 013
Section 4 - Assessments
OSATS
Hysterectomy Required 10 Training Programme Form 025
Open/Close abdomen using vertical incision Required 10 Training Programme Form 035
TAH+/- BSO (OSATS only after min 10 completed Required 10 Training Programme Form 025
Operative laparoscopy Required 10 Training Programme Form 036
Operative hysterectomy Required 10 Training Programme Form 004
Diagnostic hysterectomy Required 10 Training Programme Form 030